ORIGINAL ARTICLEA More Aggressive Approach to Emergency Embolectomy for Acute Pulmonary Embolism
Section snippets
PATIENTS AND METHODS
All patients in this study gave authorization to be involved in clinical research. The Mayo Clinic Institutional Review Board approved this retrospective study, waiving the requirement for study-specific consent.
Medical records from April 1, 2001, through March 31, 2009, were searched to identify patients with acute PE who underwent emergency APE at Mayo Clinic (Rochester, MN). Data abstracted from the patient records included medical history, clinical notes, surgical notes, and
RESULTS
Eighteen patients met the inclusion criteria for the study. Patient characteristics are presented in Table 1. The diagnosis of massive PE was established by echocardiography or computed tomography (or both) (Figure 1). The principal indications for APE were cardiogenic shock (n=12; 67%), severe RV dysfunction as shown by echocardiography (n=5; 28%), and large PFO (n=1; 6%) (Table 2). Seven patients (39%) had an embolus in transit, including one in transit across a PFO (Figure 2). Fifteen
DISCUSSION
Acute PE remains a remarkably common clinical problem, with an average annual incidence of venous thromboembolism in the general population of the United States estimated at 1 per 1000 (approximately 250,000 incident cases).9, 10, 11 Although most patients recover with anticoagulation therapy alone,5 a subset of patients with massive APE ultimately experience hemodynamic collapse and die.12, 13 The ideal therapy for patients with documented PE is medical management with heparin derivatives and
CONCLUSION
Although most patients with acute PE respond to medical therapy, many die of persistent pulmonary vascular obstruction and right-sided heart failure. The current results of surgical embolectomy, particularly when performed with attention to complete embolectomy via separate incisions in the right and left pulmonary arteries, are encouraging. Because the mortality rate remains high among patients who undergo surgery after PEA, better stratification of patients at risk of catastrophic
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2017, Annals of Thoracic SurgeryCitation Excerpt :The analysis has been reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [25]. Our literature search yielded 56 studies involving 1,579 patients who underwent 1,590 SPE operations [6–8, 13, 16, 26–76]. Supplemental Table 8 details the PRISMA checklist.
Outcomes After Surgical Pulmonary Embolectomy for Acute Pulmonary Embolus: A Multi-Institutional Study
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2014, Critical Care ClinicsCitation Excerpt :Another series of 29 patients with submassive PE calculated an 89% survival rate after pulmonary embolectomy.113 Based on similar results, Sareyyupoglu and colleagues114 concluded that embolectomy should be considered earlier in the course of the disease, including during submassive PE. Current guidelines regarding embolectomy are discordant, but the procedure may regain some of its favor as mortality decreases and patient selection continues to improve.
This article is freely available on publication.
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Dr Sareyyupoglu is now with The Heart Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA